I. Concept
VSD is a septal defect of the right and left ventricles. This septum is what separates the heart into the right and left sides. Ventricular septal defect, sometimes called a hole in the heart, is the most common congenital heart disease in the neonatal period; it is less common in older children and adults because it may close on its own.
II. Etiology
In most cases, the cause is unknown and genetic factors may play a role; VSD is the most common type of heart defect, and some people may have a combination of other heart conditions.
III. How VSD affects the heart
Normally, the left ventricle pumps blood throughout the body and the right ventricle pumps blood to both lungs. When there is a defect between the ventricles, a large amount of oxygen-rich blood flows through the defect to the right ventricle, even though this blood has already been oxygenated and is still pumped back to both lungs. This causes the heart to need to do more work and the left atrium and left ventricle to enlarge. As more blood enters the pulmonary vasculature, it causes an increase in pulmonary vascular pressure. Over time, the increased pulmonary artery pressure continues to damage the walls of the pulmonary vessels. When the defect is small, there is less left-to-right shunting of blood, which has less impact on both the heart and both lungs.
IV. How VSD affects me
In childhood, large defects can cause breathing difficulties, so most children with VSD have the defect closed through surgery. So large defects are rare in adults, but when they do occur, they can cause shortness of breath in adults. Most adults with small defects have less pressure on the heart and both lungs and are usually asymptomatic. On physical examination, a small VSD can produce a loud murmur that can lead to endocarditis even if the defect is small.
V. What happens if the VSD is small or closes on its own
Many children with VSDs close the defect on their own and do not require surgery or other treatment. adults with self-closing VSDs usually have no murmur and a normal electrocardiogram. An ultrasound of the heart shows a localized ectopy, also known as a septal tumor, which can lead to over-medication and over-testing if we think that a septal tumor is unlikely to develop after VSD closure.
VI. What are my expectations if VSD is repaired in childhood
If the defect is large, open-heart surgery is necessary. vSD closure is usually accomplished by suturing a fiber patch or pericardial patch. The normal heart lining will eventually cover the patch and become an intrinsic part of the heart. Some defects can be closed without a patch. Some VSDs can now be closed by intervention.
Patients with normal pulmonary artery pressure after ventricular defect repair have a normal life expectancy. There is no commonality of late onset problems, and a small percentage of patients may have heart valve problems. Pulmonary hypertension is likely to occur in patients with large VSDs.
VII. If the defect does not heal spontaneously, does it still need to be repaired in adulthood
In general, repair of small VSDs is not recommended unless the patient has had endocarditis and it may be caused by the VSD or the location of the VSD affects the heart valves. If the VSD is large, the ability to close the defect depends on the intrapulmonary pressure. Lower intrapulmonary pressures will benefit from the procedure, whereas the benefit of higher intrapulmonary pressures is uncertain.
VIII. Problems you will encounter
Patients with small VSDs are at risk for endocarditis. The aortic valve may not close adequately and require monitoring.
Patients with early VSD repair are unlikely to have serious long-term problems. If the VSD is completely repaired by patching, the risk of developing endocarditis later in life is low. Almost no arrhythmias occur. A proportion of people have myocardial contractile weakness after VSD repair. If the heart failure is caused by myocardial contraction weakness, diuretics are often used to control fluid intake, mechanical assistance to heart pumping function, and medications to control blood pressure. patients with VSD combined with pulmonary hypertension require medication.
IX. Ongoing concerns.
1.Medical follow-up
Your cardiologist will perform a routine physical examination. If your VSD is small or closed in childhood and there are no other problems, a follow-up visit every 3-5 years is sufficient.
2. What do I need to do in the future?
Only if you have heart failure or combined pulmonary hypertension is medication needed. If necessary, your doctor will test your condition by non-invasive methods, including cardiac ultrasound, ambulatory electrocardiogram, exercise stress test, and electrocardiogram. These measures can help determine if cardiac catheterization is needed.
3. Activity Restriction
Most patients do not require activity restriction. However, if you have pulmonary hypertension or poor heart pumping capacity, you should limit your activity to what you can tolerate. Your physician will help you decide if you need to limit your activity.
4. Endocarditis Control
According to most recommendations of the American Heart Association, endocarditis control is not required for unrepaired VSDs, and prophylaxis is required for six months after a successful VSD repair. See the Endocarditis section for details.
5. Pregnancy
Once the VSD is closed and there is no pulmonary hypertension, the risk in pregnancy is low. If the VSD is not closed, it is necessary to inform your physician. Unless pulmonary hypertension is present, pregnancy is tolerable and the risks for yourself and your child should be clear before you decide to become pregnant. For more information see the section on pregnancy and genetic counseling.
6. Do you need another surgery?
Patients who have had a VSD repair rarely need a second surgery unless a residual leak in the patch or a new defect is later discovered. In this case, the need for surgery depends on the size of the residual defect.